Healthcare Provider Details

I. General information

NPI: 1639828940
Provider Name (Legal Business Name): ANTHONY FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 S STATE ROAD 7
WELLINGTON FL
33414-6134
US

IV. Provider business mailing address

122 MONTEREY WAY
WEST PALM BEACH FL
33411-7801
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-9441
  • Fax:
Mailing address:
  • Phone: 561-685-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: